Second opinion: It’s time to take suicide seriously instead of tinkering around the edges

Suicide is back in the news again. Since the death of Donal Walsh, who made an impassioned plea for young people to choose life not death, there has been widespread media coverage about Ireland's suicide problem.

A coroner has claimed a 400 per cent increase in suicide rates. RTÉ has covered suicide many times in the past few weeks. Most of this coverage has been sentimental, ill-informed, misleading or sensational.

Well-meaning people on TV, radio and in newspapers have advised us that the most important thing to do with life is to live it. If only it was that simple. All doctors would have to do to prevent most chronic health problems is tell alcoholics to stop drinking, nicotine addicts to stop smoking and fat people to stop overeating.

Unfortunately exhortation, no matter how passionate, does not change health behaviour or make people feel less depressed.

The point about those who feel suicidal is that they don’t want to live the life they have. That is why they kill themselves. Depressed people see the world through black-tinted spectacles.

They look inwards and don’t like the view. Telling people who want to take their own lives that life is wonderful is about as useless as telling someone with cancer that the disease is all in their head.

It changes nothing and may have the opposite effect, making suicidal people feel worse than they already do. “Why can’t I feel life is worth living? What’s wrong with me?”

Death by suicide
About 500 Irish people take their own lives every year. This is about the same number as those who die from prostate and colon cancers, and diabetes.

The 2011 report from the National Office for Suicide Prevention (NOSP) shows that Ireland has the sixth lowest rate of death by suicide in the EU at 11.4 per 100,000. Greece has the lowest rate at 3.9 and Lithuania the highest at 34.0. Ireland is the fourth highest in the EU for 15 to 24 year olds at 13.9.

Suicide in Ireland 2003-2008, recently published by 3Ts, found a four-fold increased risk of suicide in young males aged 16-20. In 2011 almost 10,000 individuals (12,216 visits) attended a hospital because of deliberate self-harm.

Since the publication of the Report of the National Task force on Suicide in 1998 and Reach Out National Strategy for Action on Suicide Prevention 2005-2014, there has been little change in Ireland's suicide rates.

The OECD report, Health at a Glance 2012, shows that between 1995 and 2010 Ireland achieved the lowest reduction (3 per cent) in suicide rates in the EU.

Even allowing for the fact that Ireland’s numbers were lower to start with than many other countries, this percentage reduction is very low given the plethora of services provided by statutory and voluntary organisations.

Italy and Spain have suicide rates that are about half that of Ireland and achieved reductions of 22 and 19 per cent respectively over the same time period. Why is this?

Different services
Services for those who are suicidal are all over the shop. In 2011 NOSP allocated nearly three-quarters of its budget to 28 agencies. These are all doing different things – helplines, training, counselling, help for bereaved parents, and so on.

There is no joined-up thinking. If these agencies were providing two or three best practice services throughout the State instead of bits and pieces of a whole lot of services to a few people, it would make a big difference.

Irish society is illiterate as far as mental health is concerned. The 3Ts report shows that, although almost everyone who takes their own life tells someone how they feel in the days before they kill themselves, the listeners do not know what to do. They would probably know how to respond if someone disclosed a physical health problem.

Fifteen years ago the report of National Task Force on Suicide recommended that reports about suicide in the media should “be limited to particular cases where it is thought to be in the public interest to do so”. The opposite happens in Ireland.

Someone dying of diabetes does not make headlines. Suicide must be treated in the same way as cancer and other physical health problems.

Best practice, centres of excellence, and the same prevention and treatment services throughout the State must be put in place instead of 28 different organisations doing their own thing. It is time for change.

Dr Jacky Jones is a former HSE regional manager of health promotion
jjones@irishtimes.com